There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Malignant Otitis Externa in Patients with Diabetes Mellitus
The management of malignant otitis externa (MOE) in patients with diabetes mellitus (DM) involves a comprehensive approach to control the infection and manage the underlying condition.
- Control of diabetes is crucial in the management of MOE, as uncontrolled diabetes can lead to poor outcomes 1.
- The use of proper antibiotics, debridement of necrotic tissue, and sometimes aggressive surgical management are essential in treating MOE 1, 2.
- Local debridement and local and systemic antibiotic treatment can be sufficient to control the disease, especially in cases where Pseudomonas aeruginosa is the causative organism 1.
- Facial nerve decompression may be necessary in cases of facial paralysis, and hyperbaric oxygen therapy can be performed in cases of facial nerve palsy 1.
Monitoring of Therapy Response
Monitoring of therapy response is crucial in the management of MOE.
- Inflammatory markers, such as erythrocyte sedimentation rate, can reflect the treatment response 3.
- Close monitoring of inflammatory parameters is key in predicting the prognosis of MOE 3.
- Radiological assessments, such as computed tomography and scintigraphy, can help in evaluating the extent of the disease and monitoring the response to treatment 1, 4.
Role of Surgery
The role of surgery in the management of MOE is not well established.
- Surgical intervention may be necessary in cases with poor facial nerve function at presentation 2.
- However, surgical intervention did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in one study 2.
- Tympanomastoidectomy and external auditory canal debridement and biopsy are some of the surgical procedures that may be performed in the management of MOE 2.
Fungal Infections
Fungal infections, such as Candida orthopsilosis, can occasionally cause MOE, especially in patients with uncontrolled diabetes mellitus or immunosuppression 5.